Diagnostic Dilemma #1

November 7, 2006

The first in our series of clinical cases with difficult management questions…

Question: 59 y.o. male with pmh notable for hyperlipidemia. Pt had normal lft's, which increased mildly when he was put on a statin. His basic hepatitis screen including A, B and C were all negative, but an iron/tibc was 61% with a nl ferritin. A hemochromatosis gene analysis was sent which revealed a single mutation c282y-and he was designated a carrier. U/s showed a midly heterogeneous hepatic echotexture with no discrete lesions.
Questions
1: would you stop the statin?
2. would you consider phlebotomy?
3. would you consider a liver bx given his heterogeneous hepatic echotexture?
4. what's his longterm prognosis?

One Response to Diagnostic Dilemma #1

  1. Charles Maltz on March 17, 2007 at 11:09 pm

    This is good question because this type of case comes up quite often. This individual does not have genetic hemochromatosis but has NAFLD. His statin should be continued, and of course he needs neither liver biopsy nor phlebotomy. An excellent discussion of statins and abnormal lft’s can be found in:

    The American Journal of Cardiology (www.AJConline.org) Vol 97 (8A) April 17, 2006

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